Department of Medicine, Division of Critical Care, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
UBC Southern Medical Program and Department of Psychology, University of British Columbia Okanagan, Kelowna, British Columbia.
Med Educ. 2017 Jul;51(7):732-739. doi: 10.1111/medu.13344.
The erosion of empathy in medical students is well documented. Both the hidden curriculum associated with poor role modelling and a sense of burnout have been proposed as key factors, but the precise mechanisms by which this loss of empathy occurs have not been elaborated.
In the context of a course designed to help students manage the hidden curriculum, we collected data that raised questions about current conceptualisations of the aspects of medical training that lead to loss of empathy.
We held nine sessions in the first year of clinical clerkship, in which we asked students to bring to the group their experiences of the hidden curriculum for reflection. Course sessions were recorded, transcribed and qualitatively analysed, and themes were generated for further exploration.
We identified an identity developmental trajectory in early clerkship in which students started with feelings of excitement, transitioned quickly to 'shock and awe', progressed into 'survival mode' and then passed into a stage of 'recovery'. Interestingly, in the early stages, students' sense of empathic virtuosity was reinforced. It was not until later, when students were more comfortable in their clinical role, that they reported their tendency to connect with the patient only as an afterthought to the encounter, or not at all, and needed to remind themselves to care.
We offer new data for consideration with regard to medical students' loss of empathy during early clinical training that suggest it is the process of making patient care routine that shifts the patient from the status of an individual with suffering to the object of the work of being a physician.
医学生同理心的缺失已被充分记录。不良榜样相关的隐性课程和职业倦怠感都被认为是关键因素，但同理心丧失的确切机制尚未详细阐述。
在一门旨在帮助学生应对隐性课程的课程中，我们收集的数据提出了一些问题，这些问题涉及导致同理心丧失的医学培训方面。
在临床实习的第一年，我们进行了九次课程，要求学生将隐性课程的经历带到小组中进行反思。课程会议进行了录音、转录和定性分析，并生成了主题以进行进一步探讨。
我们确定了早期实习中身份发展的轨迹，学生从兴奋的感觉开始，迅速过渡到“震惊和敬畏”，进入“生存模式”，然后进入“恢复”阶段。有趣的是，在早期阶段，学生的同理心技能感得到了加强。直到后来，当学生对自己的临床角色更加舒适时，他们才报告说自己倾向于将与患者的联系仅仅作为遇到患者的事后想法，或者根本不联系，并且需要提醒自己关心患者。
我们提供了新的数据，以考虑医学生在早期临床培训中同理心丧失的问题，这表明正是将患者护理常规化的过程将患者从有痛苦的个体转变为医生工作的对象。
